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Case Reports 2004; 25(4): 307-309 PubMed PMID: 15361823 Citation  Keywords:  Acromegaly:blood, Empty Sella Syndrome:blood, Female, Growth Hormone:blood, Humans, Magnetic Resonance Imaging, Middle Aged, Octreotide:therapeutic use, Treatment Outcome,.   

: The normal functions of the pituitary gland may be suppressed when the gland is compressed onto the sella floor by arachnoid tissue extending through an impaired sella diaphragm. Interestingly, pituitary hormone hypo- and hypersecretion, including acromegaly, have been observed in patients with an 'empty sella'(1-4). This 'empty sella syndrome' has been classified into a primary form, in which no inciting factor (pituitary irradiation or surgery for a pituitary tumor) is present, and a secondary form, in which the empty sella occurs after pituitary procedures. In this report we describe a patient who presented with clinical and biochemical features of acromegaly and who had an empty sella on pituitary magnetic resonance imaging (MRI)....

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Case Reports 2004; 25(1-2): 45-48 PubMed PMID: 15159681 Citation  Keywords:  Analgesics, Non-Narcotic:therapeutic use, Blepharospasm:diagnosis, Botulinum Toxins, Type A:therapeutic use, Dronabinol:therapeutic use, Dystonic Disorders:diagnosis, Female, Humans, Middle Aged, Treatment Outcome,.   

: The benign essential blepharospasm is a subliminal form of primary torsion dystonia with still uncertain aetiology. It is characterized by involuntary convulsive muscle contractions of the M. orbicularis occuli, accompanied by unbearable pain of the cornea, eye bulb and the muscle itself. It has been suggested that blepharospasm is neurobiologically based on a dysfunction of the basal ganglia and an impairment of the dopamine neurotransmitter system. Therefore, therapy of blepharospasm contains administration of anticholinergic- and tranquillizing drugs as well as botulinum toxin as neuromuscular blocking agent. However serious side effects can be observed as well as failure of therapy. In the brain a dense co-localisation of cannabinoid (CB1) and dopamine (D2)-receptor was identified which had been associated with the influence of cannabinoids on the dopaminergic reward system. Additionally, it has been demonstrated that cannabinoids may have an impact on the central GABAergic and glutaminergic transmitter system and thus might be involved in the influence of movement control. In the present case we administered the cannabinoid receptor agonist Dronabinol (Delta-9-Tetrahydrocannabinol) to a woman suffering from severe blepharospasm. Multiple treatments with botulinum toxin did not reveal a long-lasting beneficial effect. By contrast, treatment with 25 mg Dronabinol for several weeks improved the patients' social life and attenuated pain perception remarkably. This case study demonstrates that the therapy with a cannabinoid agonist may provide a novel tool in the treatment of blepharospasm and maybe of other multifactorial related movement disorders....

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Clinical Trial 2003; 24(6): 463-467 PubMed PMID: 15073577 Citation  Keywords:  Adult, Continuous Positive Airway Pressure, Humans, Luteinizing Hormone:blood, Male, Middle Aged, Pituitary Gland:physiology, Sleep Apnea, Obstructive:physiopathology, Testis:physiology, Testosterone:blood, Treatment Outcome,.   

OBJECTIVES: Decreased libido and a decline in morning serum testosterone levels were reported in men with obstructive sleep apnea (OSA). Our study aimed to evaluate the pituitary-gonadal axis in middle age men with OSA before and after treatment with nasal continuous positive airway pressure (CPAP).

MATERIAL AND METHODS: Measurement of the nocturnal serum luteinizing hormone (LH) and testosterone levels and sleep recordings before and after nine months of CPAP treatment in five men with OSA aged 49.5+/-5.2 years. Patients were evaluated during nocturnal sleep at base line and during CPAP treatment. Serum LH and testosterone levels were determined at 20 minutes interval between 1900h and 0700h with concomitant determination of sleep quality, respiration and oxygen saturation.

RESULTS: At base line, patients had higher RDI and PaO2<90%, lower mean and integrated (AUC) values of LH and testosterone. During CPAP treatment, RDI and PaO2<90% were normal. Mean and AUC values of testosterone and LH increased.

CONCLUSIONS: OSA in men is associated with dysfunction of the pituitary-gonadal axis. The central suppression of nocturnal testosterone in these patients is partially corrected during chronic CPAP treatment....

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Comparative Study 2003; 24(6): 425-430 PubMed PMID: 15073569 Citation  Keywords:  Adenoma:pathology, Adenoma, Oxyphilic:pathology, Adolescent, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Pituitary Neoplasms:pathology, Prognosis, Retrospective Studies, Sex Characteristics, Treatment Out.   

OBJECTIVES: Clinically non-functioning pituitary adenomas are common tumors of the pituitary gland. No studies have yet documented gender-related differences in the growth and presentation of these tumors and nothing is known about their effects on their subsequent surgical outcome and prognosis.

SETTING AND DESIGN: Twenty-eight patients with non-functioning pituitary adenoma, that met strict inclusion criteria, and that underwent surgical treatment between January 1990 and June 1997, were retrospectively reviewed.

METHODS: The patient charts, as well as histological (incl. immunohistochemistry) and electron microscopic findings were analyzed. Tumor invasiveness was classified according to the modified Hardy criteria.

MAIN FINDINGS: Eleven patients were women and seventeen were men; the female-to-male-ratio was 1:1.5. Men were significantly older, both at diagnosis and surgery. Visual field defect and visual acuity deficit were the most common presenting symptoms with similar occurrence both in women and men, whereas blindness predominated in women. Microadenomas and invasive adenomas did not differ significantly in MIB-1 index, but patients less than 35 years old had higher MIB-1 indices (n=4, 1.72+/-1.15), than did patients over 45 years (n=11, 0.63+/-0.42) (p: n.s.). MIB-1 labeling indices were higher in adenomas of female compared to male patients (1.5 +/-1.2 vs. 0.8+/-1.8; p < 0.003). The overall outcome was significantly worse in women than in men.

CONCLUSION: The biology and the clinical course of clinically non-functioning pituitary adenoma seem to differ in women and men. In men, tumors are smaller and less invasive at surgery, and the outcome is better than in women. The present findings may justify a more aggressive therapeutic approach to clinically non-functioning pituitary adenomas in women than in men, especially to improve the availability of viable pituitary cells at the time of surgery....

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Clinical Trial 2002; 23(2): 109-113 PubMed PMID: 12011795 Citation  Keywords:  Adult, Antidepressive Agents, Tricyclic:administration & dosage, Depressive Disorder, Major:drug therapy, Double-Blind Method, Female, Humans, Imipramine:administration & dosage, Inpatients, Male, Middle Aged, Phototherapy, Recurrence, Seasons, Treatment .   

INTRODUCTION: The aim of a double-blind study was to assess the efficacy of bright light therapy and/or imipramine in the treatment of inpatients suffering with recurrent non-seasonal major depressive disorder.

METHOD: 34 in-patients with DSM-III-R diagnosis of major depressive disorder, recurrent type, were randomly allocated into 3 treatment groups. After 4-day washout period with baseline assessment they underwent 3 weeks of different types of treatment: a) Group A: bright light therapy (5000 lux from 6-8 a.m.) and imipramine 150 mg/day. b) Group B: bright light therapy (5000 lux from 6-8 a.m.) and imipramine-like placebo. c) Group C: dim red light (500 lux from 6-8 a.m.) and imipramine 150 mg/day. Outcome measures included weekly Hamilton Psychiatric Rating Scale for Depression, Clinical Global Impression Scale, Montgomery and Asberg Psychiatric Rating Scale for Depression and Beck Depression Inventory.

RESULTS: Patients of all three groups improved significantly. The improvement of the patients of group B treated with bright light therapy plus placebo was superior to the other two groups, but not significantly.

CONCLUSION: Bright light therapy can be effective in the treatment of non-seasonal major depressive disorder....

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Clinical Trial 2002; 23(1): 55-60 PubMed PMID: 11880863 Citation  Keywords:  Aged, Aged, 80 and over, Anti-Anxiety Agents:administration & dosage, Benzodiazepines:administration & dosage, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Melatonin:therapeutic use, Middle Aged, Sleep:drug effects, Treatment Fai.   

OBJECTIVE: The present double blind-placebo controlled study was carried out to assess whether melatonin (3 mg p.o., fast release form) could be useful to reduce benzodiazepine dosage in old patients with minor sleep disturbance. The possible correlation of urinary excretion of 6-sulphatoxymelatonin (aMT6s) before starting treatment and outcome of treatment was also examined.

METHODS: Forty-five patients (36 females, 70.5 +/- 13.1 years old) regularly taking anxiolytic benzodiazepines in low doses were studied. Overall quality of morning freshness, daily alertness, sleep quality, and sleep onset and offset time were assessed from structured clinical interviews and from logs completed by the patients. Patients were randomized to receive either melatonin or placebo for 6 weeks. On day 14 of treatment, benzodiazepine dose was reduced by half and on day 28, it was halted. No significant modifications of sleep or wakefulness were detected after benzodiazepine withdrawal. As compared to basal, there was a general lack of changes in quality of wakefulness or sleep in patients taking melatonin or placebo. Sleep quality of patients taking melatonin during the first two weeks of treatment was significantly lower than that of placebo. Melatonin advanced sleep onset by 27.9 +/- 11.9 min and decreased significantly the variability of sleep onset time (p= 0.03). The urinary concentration of aMT6s prior to the study did not correlate with any parameter examined.

CONCLUSION: The present study does not support melatonin efficacy to reduce the use of benzodiazepines in low doses. This contrasted with the demonstrable effectiveness of melatonin to reduce benzodiazepine consumption in insomniac patients when used in hypnotic amounts....

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Journal Article 2018; 39(4): 281-287 PubMed PMID: 30531701 Citation  Keywords:  Adolescent, Adult, Aged, Aged, 80 and over, Brain Neoplasms:radiotherapy, Female, Glioblastoma:radiotherapy, Humans, Male, Middle Aged, Neoplasm Recurrence, Local:radiotherapy, Palliative Care, Radiosurgery, Retrospective Studies, Survival Rate, Treatment.   

OBJECTIVE: Local recurrence of glioblastoma is observed in most patients after standard oncologic treatment (surgery, chemotherapy and radiotherapy). Stereotactic radiosurgery with the Leksell Gamma Knife (SRS with LGK) was used to treat recurrent tumors in selected cases, and retrospective analysis of treatment outcome was performed. METHODS: Altogether 126 patients were treated for glioblastoma at our center from 1992-2014. Sixty-nine patients (55%) were male and 57 (45%) female, with a median age of 56 years (range 17-80 years). Prior to LGK radiosurgery, 123 (98%) underwent surgery, 126 (100%) radiotherapy and 116 (92%) chemotherapy. The median Karnofsky score before LGK radiosurgery was 90% (range 50-100), and the median time from GBM diagnosis to LGK radiosurgery was 12 months (range 1-96 months). The median tumor volume was 3.75 cm3 (range 0.04-37.10 cm3). LGK radiosurgery was performed in a single fraction with a median minimal tumor dose of 12 Gy (range 10-25 Gy) on a median 50% (range 40-86%) isodose line. Two and more LGK radiosurgeries were performed in 19 (15%) cases, a median interval of 9.6 months (range 2-45 months) from the initial LGK radiosurgery. The median prescribed dose in these patients was 12.6 Gy (range 10-15 Gy), and the median volume 5.8 cm3 (range 0.1-13.7 cm3). RESULTS: The median survival from GBM diagnosis was 20 months (range 6-237 months). The median survival after LGK radiosurgery was 7 months (range 1-223 months). The one year survival after LGK radiosurgery was 27%, 2 years 8%, and more than 3 years 4%. Tumor regression on MR images was observed in 17% of patients at a median interval of 7 months. The median interval to tumor progression on MR images after LGK treatment was 8.5 months. No treatment-related radionecrosis with expansive behaviour was detected after radiosurgery. CONCLUSION: We show that LGK radiosurgery is a safe palliative treatment modality in patients with recurrent GBM....

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